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16-08-2011 | Mental health | Article

Trauma and PTSD common in schizophrenia patients with substance abuse

Abstract

Free abstract

MedWire News: Trauma and comorbid post-traumatic stress disorder (PTSD) are common in patients with schizophrenia who are substance abusers, UK research shows.

"Exposure to traumatic events in the general population is high, with estimates from community samples ranging from 40% to 80% [and] there is some evidence that exposure to trauma in those suffering schizophrenia and severe mental illness may be even higher," explain Nicholas Tarrier and Alicia Picken from the University of Manchester.

They add that substance abuse is also common among patients with schizophrenia.

To investigate the occurrence of trauma and comorbid PTSD in patients with a dual diagnosis of schizophrenia and substance abuse, and to assess whether such trauma is related to patients' behavior or illness, the team studied 110 such patients who participated in the Motivational Interventions for Drug and Alcohol Misuse in Schizophrenia trial.

All of the patients were assessed for PTSD was using the Posttraumatic Stress Diagnostic Scale (PDS). Respondents were asked to read through a list of traumatic events and to mark any event they had witnessed or experienced. They were then asked which of the experiences they marked affected them the most and to briefly describe the event.

As certain types of trauma are specific to the schizophrenia population, such as involuntary hospitalization, distressing psychotic symptoms, and treatments, these experiences were added to the list of traumatic experiences (modified-criterion A).

The participants were also assessed for schizophrenia severity using the Positive and Negative Syndrome Scale (PANSS), and the Calgary Depression Scale (CDS) was used to assess depression levels.

In total, 100 (91%) patients reported at least one traumatic event, with each individual reporting an average of 4.3 events.

The most commonly reported traumas were related to patients' illness regarding hospitalizations and delusions. The most common events that were not directly related to illness were serious injuries, physical assault by a stranger, and sexual contact when younger than 18 years by an older individual.

Overall, 63 patients (57%) reported a traumatic event that met modified-criterion A for PTSD, while 31 patients (28%) met criteria for full PTSD.

The patients with full PTSD had significantly higher positive symptom scores on the PANSS and higher CDS scores than those without PTSD, at 18 versus 15, and 9.74 versus 4.65, respectively.

Tarrier and Picken conclude in the journal Comprehensive Psychiatry: "Exposures to traumatic events and comorbid PTSD are high but are inflated by reactions to illness-related events such as hospitalization and psychotic symptoms."

They add: "The research here adds to a body of evidence suggesting that it is important to gather information on trauma history and its consequences, particularly with regard to understanding the impact of hospitalization and treatment of acute exacerbations and supporting individuals when they return to the community."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Mark Cowen

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